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An influenza pandemic could impair the military's readiness, jeopardize ongoing military operations abroad, and threaten the day-to-day functioning of the Department of Defense (DOD) due to a large percentage of sick or absent personnel. GAO was asked to examine DOD's pandemic influenza planning and preparedness efforts. GAO previously reported that DOD had taken numerous actions to prepare departmentwide, but faced four management challenges as it continued its efforts. GAO made recommendations to address these challenges and DOD generally concurred with them. This report focuses on DOD's combatant commands (COCOM) and addresses (1) actions the COCOMs have taken to prepare and (2) management challenges COCOMs face going forward. GAO reviewed guidance, plans, and after-action reports and interviewed DOD officials and more than 200 officials at the 9 COCOMs.

COCOMs have taken numerous management and operational actions to prepare for an influenza pandemic, and the COCOMs' efforts are evolving. Each of DOD's nine COCOMs has established or intends to establish a working group to prepare for an influenza pandemic. Additionally, eight of the nine COCOMs have developed or are developing a pandemic influenza plan. Half of the COCOMs have conducted exercises to test their pandemic influenza plans and several are taking steps to address lessons learned. Five of the nine COCOMs have started to use various media, training programs, and outreach events to inform their personnel about pandemic influenza. Each of the geographic COCOMs has worked or plans to work with nations in its area of responsibility to raise awareness about and assess capabilities for responding to avian and pandemic influenza. Although COCOMs have taken numerous actions, GAO identified three management challenges that may prevent the COCOMs from being fully prepared to effectively protect personnel and perform missions during an influenza pandemic, two of which are related to issues GAO previously recommended that DOD address. First, the roles, responsibilities, and authorities of key organizations relative to others involved in DOD's planning efforts remained unclear in part due to the continued lack of sufficiently detailed guidance from the Secretary of Defense or his designee. As a result, the unity and cohesiveness of DOD's efforts could be impaired and the potential remains for confusion and gaps or duplication in actions taken by the COCOMs relative to the military services and other DOD organizations, such as in completing actions assigned to DOD in the Implementation Plan for the National Strategy for Pandemic Influenza. Second, GAO identified a disconnect between the COCOMs' planning and preparedness activities and resources, including funding and personnel, to complete these activities, in part, because DOD's guidance does not identify the resources required to complete these activities. The continued lack of a link between planning and preparedness activities and resources may limit the COCOMs' ability to effectively prepare for and respond to an influenza pandemic, including COCOMs' ability to exercise pandemic influenza plans in the future. Third, GAO identified factors that are beyond the COCOMs' control--such as limited detailed guidance from other federal agencies on support expected from DOD, lack of control over DOD's stockpile of antivirals, limited information on decisions that other nations may make during an influenza pandemic, reliance on civilian medical providers for medical care, and reliance on military services for medical materiel--that they have not yet fully planned how to mitigate. While GAO recognizes the challenge of pandemic influenza planning, not yet developing options to mitigate the effects of factors that are beyond their control may place at risk the COCOM commanders' ability to protect their personnel and perform missions during an influenza pandemic. For example, if a nation decides to close its borders at the start of a pandemic, COCOMs and installations may not be able to obtain needed supplies, such as antivirals.

Recommendations for Executive Action

Status: Closed - Implemented

Comments: DOD, through U.S. Northern Command as the global synchronizer for pandemic influenza planning, collected information from the combatant commands on funding requirements related to pandemic influenza preparedness and submitted this information through DOD's formal budget and funding process. Through this process, five of the combatant commands (U.S. Northern Command, U.S. European Command, U.S. Pacific Command, U.S. Central Command, and U.S. Transportation Command) obtained about $25 million for fiscal years 2009 through 2013 for pandemic influenza planning and exercises. Future pandemic influenza-related funding requirements will be addressed through DOD's established budget process. This satisfies the intent of our recommendation.

Recommendation: To increase the likelihood that the COCOMs can effectively continue their pandemic influenza planning and preparedness activities, including accomplishing actions assigned to DOD in the national implementation plan within established time frames, the Secretary of Defense should instruct the ASD(HD&ASA) to work with the Under Secretary of Defense (Comptroller) to identify the sources and types of resources that COCOMs need to accomplish their pandemic influenza planning and preparedness activities.

Agency Affected: Department of Defense

Status: Closed - Implemented

Comments: Revisions to DOD's 2008 Joint Strategic Capabilities Plan, as well as guidance from the Secretary of Defense during a periodic review of U.S. Northern Command's pandemic influenza global synchronization plan, clarified and better defined U.S. Northern Command's role as global synchronizer. This satisfies the intent of our recommendation.

Recommendation: To reduce the potential for confusion, gaps, and duplications in the COCOMs' pandemic influenza planning and preparedness efforts and enhance the unity and cohesiveness of DOD's efforts, the Secretary of Defense should instruct the ASD(HD&ASA) to issue guidance that specifies NORTHCOM's roles and responsibilities as global synchronizer relative to the roles and responsibilities of the various organizations leading and supporting the department's pandemic influenza planning.

Agency Affected: Department of Defense

Status: Closed - Implemented

Comments: The 14 national implementation plan tasks assigned to the Joint Staff as the lead organization within DOD, which includes tasks to be performed by the combatant commands, have been completed. According to DOD, the department's Global Pandemic Influenza Planning Team developed recommendations for the division of responsibilities, which were included in U.S. Northern Command's global synchronization plan for pandemic influenza. Additionally, DOD assigned pandemic influenza-related tasks to the combatant commands in its 2008 Joint Strategic Capabilities Plan.

Recommendation: To reduce the potential for confusion, gaps, and duplications in the COCOMs' pandemic influenza planning and preparedness efforts and enhance the unity and cohesiveness of DOD's efforts, the Secretary of Defense should instruct the Assistant Secretary of Defense for Homeland Defense and Americas' Security Affairs (ASD(HD&ASA)) to issue guidance that specifies which of the actions assigned to DOD in the Implementation Plan for the National Strategy for Pandemic Influenza and other pandemic influenza-related planning tasks apply to the individual COCOMs, military services, and other organizations within DOD, as well as what constitutes fulfillment of these actions.

Agency Affected: Department of Defense

Status: Closed - Implemented

Comments: The combatant commands are increasingly inviting representatives from the United Nations, including the World Health Organization and the Food and Agriculture Organization; host and neighboring nations; and other federal government agencies to exercises and conferences to share information and fill information gaps. Additionally, U.S. Northern Command and U.S. Pacific Command, along with the military services and installations, are increasingly working and planning with state, local, and tribal representatives. DOD views updating and reviewing plans to ensure that they are current as a continuous process driven by changes in policy, science, and environmental factors. This satisfies the intent of our recommendation.

Recommendation: To increase the likelihood that COCOMs are more fully prepared to protect personnel and perform ongoing missions during an influenza pandemic, the Secretary of Defense should instruct the Joint Staff to work with the COCOMs to develop options to mitigate the effects of factors that are beyond the COCOMs' control, such as limited detailed information from other federal agencies on the support expected from DOD, lack of control over DOD's antiviral stockpile, limited information on decisions that other nations may make during an influenza pandemic, reliance on civilian medical providers for medical care, and reliance on military services for medical materiel.